Hormone treatments. The days when you have pelvic pain may coincide with a particular phase of your menstrual cycle and the hormonal changes that control ovulation and menstruation. Birth control pills or other hormonal medications may help relieve cyclic pelvic pain.

Antibiotics. If an infection is the source of your pain, your doctor may prescribe antibiotics.

Antidepressants. Certain types of antidepressants can be helpful for a variety of chronic pain syndromes. Tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and others, seem to have pain-relieving as well as antidepressant effects. They may help improve chronic pelvic pain even in women who don't have depression.

Therapies

Your doctor may recommend specific therapies or procedures as a part of your treatment for chronic pelvic pain. These may include:

Physical therapy. Applications of heat and cold to your abdomen, stretching exercises, massage and other relaxation techniques may improve your chronic pelvic pain. Your doctor might also recommend exercises to strengthen your pelvic floor muscles. A physical therapist can assist you with these therapies and help you develop coping strategies for the pain. Sometimes physical therapists target specific points of pain using transcutaneous electrical nerve stimulation (TENS), in which electrodes deliver electrical impulses to nearby nerve pathways, or by teaching biofeedback, a technique that helps you identify areas of tight muscles so you can learn to relax those areas.

Neurostimulation (spinal cord stimulation). This treatment involves implanting a device that blocks nerve pathways so the pain signal can't reach the brain. It may be helpful, depending on the cause of your pelvic pain.

Trigger point injections. If your doctor finds a specific point where you feel pain, you may benefit from direct injection of a numbing medicine into a painful spot (trigger point). The medicine, usually a long-acting local anesthetic, can block pain and ease discomfort.

Counseling. Your pain could be intertwined with depression, sexual abuse, a personality disorder, a troubled marriage or a family crisis. Getting help for psychological, social, spiritual and emotional challenges may be an essential part of your treatment plan.

Surgery

To correct an underlying problem that causes chronic pelvic pain, your doctor may recommend a surgical procedure, such as:

Laparoscopic surgery. If you have endometriosis, doctors can remove the adhesions or endometrial tissue using laparoscopic surgery. During laparoscopic surgery, your surgeon inserts a slender viewing instrument (laparoscope) through a small incision near your navel and inserts instruments to remove endometrial tissue through one or more additional small incisions.

Hysterectomy. Relatively rarely, your doctor might recommend a hysterectomy and bilateral oophorectomy — surgery to remove your uterus and ovaries. Removing the ovaries deprives endometriosis of estrogen, which it needs in order to grow. Hysterectomy and oophorectomy may be an option for certain causes of pelvic pain in women past childbearing age, but usually isn't recommended.

Pain rehabilitation programs

You may need to try a combination of treatment approaches before you find what works best for you. If appropriate, you might consider entering a pain rehabilitation program. These types of programs, such as the Pain Rehabilitation Center at Mayo Clinic, typically provide a team approach to treatment, including medical and psychiatric aspects.

Relaxation techniques for health: An introduction. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/sites/nccam.nih.gov/files/relaxation_introduction.pdf.Accessed April 14, 2013.

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